| NPI | 1093866006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 29605) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 29605) |
| 174400000X Specialist (Licence: NC 29605) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-10-05 |